Healthcare Provider Details

I. General information

NPI: 1508855305
Provider Name (Legal Business Name): POCAHONTAS MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MEDICAL CENTER DR
POCAHONTAS AR
72455-9438
US

IV. Provider business mailing address

2901 MEDICAL CENTER DR
POCAHONTAS AR
72455-9438
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-4467
  • Fax: 870-892-4407
Mailing address:
  • Phone: 870-892-4467
  • Fax: 870-892-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT E HOLT
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 870-892-4467